Induction of labour (IOL) is the use of drugs or interventions to start labour. Women with uncomplicated pregnancies should usually be offered IOL between 41+0 and 42+0 weeks. One of the recommended regimens is one Cycle of vaginal PGE2 tablets (pessaries) or gel; one dose followed by a second dose after 6 hours (up to a maximum of 2). If induction fails subsequent management options include a further attempt to induce labour or caesarean section.1
We reviewed all IOL cases over a 3 year period in our unit who had 3 or more pessaries (N = 312). Maternal outcomes included epidural requirements, mode of delivery, blood loss, third degree tear rate and intensive care admissions. Neonatal outcomes included unit admissions, Hypoxic Ischaemic Encephalopathy and meconium aspiration.
In our unit 8.5% of all ladies who had IOL had 3 or more pessaries over the 3 years. Of this cohort there was a 50% Caesarean section rate and 62% requested epidural. Major PPH (>1000 ml blood loss) occurred in 9% of cases and 6% of women had a 3rd degree tear. 2% of babies born after 3 or more PGE2 required admission to the neonatal unit.
Women have varied experiences of IOL and the process can have an impact on their birth experience and their health. We conclude that it is reasonable to induce labour with 3 pessaries as long as the women are counselled appropriately that their chance of vaginal delivery is 50%. Our IOL information leaflets have been updated to include this.
NICE clinical guideline 70. Induction of Labour. July 2008
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